AMA President, A/Prof Brian Owler, Doorstop, Sydney, 8 January 2015 - Co-payments/ GP consultations
BRIAN OWLER: Well, thank you for coming out. What I was going to talk about today was the changes to the GP rebates that come into effect on 19 January. We've had a lot of feedback from GPs about their unhappiness, their anger, over the proposed changes which are coming in on 19 January. These changes haven't been debated by Parliament, many people are unaware of the changes, and it's a terrible time of year to institute such far-reaching changes to general practice.
Essentially, the changes have to do with the Level A and Level B rebates, which for most people doesn't mean very much. But what it means for patients at the end of the day is that GPs will be receiving less of a rebate, and patients that are privately billed will also be receiving less back from the Government. It will mean more money out of people's pockets each time they go and see the GP, and these changes are insulting to GPs, many of whom are experienced and can provide good quality care within eight or nine minutes.
So, the changes to the rebates, for Level A and Level B, mean that for a Level B rebate, a minimum time of 10 minutes has to be spent with a patient. That's quite different to the situation now where it's based on complexity. So, those changes will mean that if a GP, an experienced GP, can deliver good quality care in eight or nine minutes, the rebate will go from $37 to $16.95, and that really is insulting to general practice, and that is why the AMA will be holding GP rallies in early February.
The GPs have asked for the opportunity to demonstrate their anger, their unhappiness, about these changes and we call on the Government to step in - the Prime Minister to step in - and actually do the right thing and make sure these changes are properly debated, and that we can have a proper debate and discussion about health policy, which is what we need if we are to have a sustainable health care system and if we are to have good general practice that can actually do the chronic disease management and prevention that this country's health system needs.
JOURNALIST: You mentioned the rallies were going to take place next month; where do you see them happening and how many doctors are you talking about?
BRIAN OWLER: Well, I think that the events that are going to be held will probably vary around the country. At this stage, we certainly have events planned in Sydney and Brisbane. It's very likely that there'll be events in every capital city. They're currently being organised, and I expect hundreds, if not thousands, of GPs to turn up to those events, which will be held - likely to be held on February 8, just before Parliament returns, when they will have the opportunity to disallow the regulations that are necessary for these changes. So, we can't stop them going through unless the Prime Minister steps in before January 19. But the Parliament does have the opportunity to disallow the regulations and actually reverse the changes once they do come back. So, once people are back from holidays, once people are paying attention to this issue once again, there will be very large events scheduled right around the country.
JOURNALIST: Can you explain the disallowance, what needs to happen - it would occur in the Senate?
BRIAN OWLER: That's right, so potentially in the Senate, because of the balance of power being with the cross-benchers, if Labor and the Greens and the cross-benchers decide, they can actually disallow the regulations, which would actually mean that they can reverse the changes. Now, this is a regulatory change, it's not a legislative change, and so those regulatory changes can be disallowed by the Senate. They have 15 sitting days to do so once Parliament returns.
JOURNALIST: What kind of support do you think you have in the Senate so far, and what's the AMA doing to push this course?
BRIAN OWLER: Well, obviously we've been talking to all political parties and as well as the cross-benchers - a number of cross-benchers have already indicated their unhappiness about these changes and what they mean for patients and out of pocket expenses. And we're optimistic that, particularly with the level of anger that GPs are showing and the lobbying efforts that they're making right across the country even now, that there will be an opportunity for a disallowance motion for these regulatory changes.
JOURNALIST: Have any of the cross-benchers actually indicated yes, we will support you?
BRIAN OWLER: Well, Nick Xenophon's been making comments about these changes, saying that they are - he described them as declaring war on doctors. Now, he's obviously unhappy with the changes. Senator Lazarus has also indicated that he's unhappy with the current proposals, and obviously we'll have to wait and see what the other cross-benchers say as well.
JOURNALIST: So, you don't think that it will make doctors spend more time with patients and increase quality of care?
BRIAN OWLER: Well look, there are many experienced GPs who are saying to us that, ‘I've been doing this for 20 years, so I can examine a patient that comes in, for instance, with a breast lump - I can take a history, examine the lump, make the appropriate referrals for diagnostic imaging and then actually explain to the patient why they think it's benign but why they should still have the test’. Now that's still quality care and they can do that in eight or nine minutes. The idea of making a 10 minute rule on the Level B consultation really is very insulting to those GPs, particularly those very experienced GPs, that can actually provide quality care. Quality is not necessarily about time. Quality is about the nature of the care that's provided. And I think - look, the AMA does not support models where it's based on six minutes for every patient, being churned through, but I think we have to recognise there are many GPs right across the country with a lot of experience, that have been doing this for a long time, that can actually provide good quality care. And to say that that experience, that expertise, is only worth now $16.95 - and from July 1, with the $5 cut, $11.95 - is a slap in the face for our experienced GPs right across the country.
JOURNALIST: What impact do you think this will have on everyday [indistinct]?
BRIAN OWLER: Well look, a lot of practices, particularly in low socioeconomic areas, are worried about their viability. People are explaining to us what it means about teaching the next generation of GPs, the amount of time that they would normally spend doing that. Now, they are going to have to make cuts -they can't cut staff, they can't cut practice nurses, they can't close their rooms. So, the only thing that they can do is pass those costs onto the patient. And so what it means for many patients is that when the rebate goes from $37 down to $16.95, that's a cut of almost $20, and that will actually have to be passed on to patients.
So, this is not about a $5 co-payment. In many cases, the difference is more like $20, and [that] will go up on July 1 as well if the $5 cut comes in. So that's what we're talking about – [it] is a very significant change to the nature of the rebate and the level of rebate that the patient will receive, and a significant increase in the out-of-pocket expenses for most patients when they go and see their GP.
JOURNALIST: Just lastly, I know you touched briefly on having [indistinct] in the Senate and the cross-benches. Have you [indistinct]?
BRIAN OWLER: Well look, obviously we talk to the Minister for Health and the new Minister who's only, obviously, been in the position for a short amount of time. I will be writing to the Prime Minister as well, and we hope that the Government will step in. Now, they've rearranged the Cabinet, they've had the reshuffle, but they're still lumped with this very poor policy. And what this provides is an opportunity for the Government to actually reset not just the faces, but the actual underlying policies - which are the real problem for this Government at the moment.
Now obviously we're also talking with Labor, the Greens, and all the crossbenchers. So there won't- no-one in particular that we're targeting. I think politicians will be hearing from GPs, but obviously also from members of the public; because at the end of the day, it's not just GPs that this affects, it's actually the out-of-pocket expenses for patients. Each time you go and see the GP, if you take your child along to go and see a GP, there will be an increase in out-of-pocket expenses. And that's what it means for patients at the end of the day, and I'm sure that they will be contacting their local members as well.
JOURNALIST: Why would the Prime Minister step in, given he's the one [indistinct] it out? [Indistinct].
BRIAN OWLER: Well, I think it's a mistake in policy. What the Government didn't do is take the opportunity to talk with the AMA, but also other health groups as well, when it introduced this proposal. This proposal was poorly thought out, there was no consultation, and if the Government is truly willing to reset for this year, for 2015, then it's got to reset these poor policies.
I mean, the problem with the co-payment is not the personalities, it's not the marketing, it's not the messaging; it's the policy. And this new policy has angered GPs even more than the old policy. So what we need to do is actually have a conversation in this country about primary care in general practice, how we make our system sustainable. We want to have that discussion, but we can't be having that discussion in the context of these very poor policies and these cuts to rebates, which are going to have adverse consequences on general practice, but also on our patients.
JOURNALIST: And is there any version of the co-payment plan that AMA would accept?
BRIAN OWLER: Well, the AMA did put forward an alternative proposal. Now, it didn't have the savings in it that the Government wanted, and what it turns out is that really, what the Government wants to do is save money to make the Budget bottom line look better. These proposals are not health policy, they're financial policy. And what we need to do is get back to discussing health policy. Every country in the world knows that to have a sustainable health care system you have to invest in general practice; you have to invest in primary care. And the mistake that this Government is making is taking $3.5 billion out of primary care, out of general practice, right at the time when it should be investing. And that's the sort of thing that we need to reverse so that we can get back to discussing how to invest in general practice, but also how to get the best out of our general practitioners as well.
8 January 2015
